STAMPED & REDACTED KARI SUZANNE RAMBO.PDF
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INTEROFFICE MEMORANDUM Maricopa County Schools Superintendent Office TO: CLERK OF THE BOARD FROM: Terri Ysaguirre SUBJECT: Affidavits — Replacement of Lost Warrants DATE: 12/28/2021 Please find attached 1 Affidavit/Notice of Claim(s) for lost warrants for inclusion on the next available Board agenda v The attached item(s) have been researched to ensure that the warrant(s) in question have not been cashed or previously re-issued. Vv The original warrant(s) have had a stop payment done. If you have any questions, please contact Terri Ysaguirre at 602-372-1245 or via e-mail at terri.ysaguirre@maricopa.gov. Approved Affidavits may be routed back to the Superintendent of School Finance Division at 4041 N. Central Avenue #1200, (12th Floor) Thank you. #33 Buckeye Elementary Kari Suzanne Rambo $4,970.00 Schools Affidavit/Claim Form Application for a Duplicate Warrant/Check (dotinitions are on page 2) STATE OF ARIZONA Note: Numbers on this form correspond to numbers on the COUNTY OF MARICOPA Instruction sheet which Is page 2 of this form. ae Nezen npr mba (1), being first sworn, upon oath deposes and says: Name/Claimant ¥ On or about 4 22/; 202] (date)(2) a warrant/check was issued to the above named per'son/entity in the amount as stated below. Such warrant/check was either never received or was subsequently inadvertently lost or destroyed and there Is no reasonable probability of its being found or presented for payment, or it was not presented for payment within one year after the date of issuance, Therefore, under penalty of perjury, claimant hereby affirms that this clairn is correct and the amount shown is due and owing, and the applicant requests that a replacement 00 warrant/check be issued to him/her in the sum of $ A 9 Lt ) (~~ (3) =< > “ Signed: Lal, Kipp oo (4) (5) Subscribed and sworn to before me this day of 20 NOTARY PUBLIC My commission expires: (seal) Note: Please attach a copy of the warrant/check if available and/or any other evidence that a warrant/check was originally issued. Warrant/Check Number Sea (if known) (6) 3 260YW4 > 3 2 Original Date of Issue _ (if known) (7) ee sik Reason for original issue of Warrant/Check (8): CI Payroll i (For Services or Goods furnished Lavoe A. arepeagt eee ) Other: §:\PROCESSES\Watrants - Duplicate or Stale\02 Forms\Schools\Scl 1? / 29 if FOAL Revised June 2015 WELLS Acknowledgment by Individual at State of County of On this it tA day of p ecejn Le £ . 20 2f . Before me, WIA Aar ie f the undersigned Notary Public, personally rs o DUEG nHe fF LKARI VI7 BE Name of Notary Public Nampa of Signer(s) (1) Proved to me on the oath of (J Personally known to me Proved to me on the basis of satisfactory evidence ‘ a \ | 2. Dprver s Lienmd ¢ (Description of 1D) io be the person(s) whose name(s) is/are subscribed to the within instrument, and acknowledged thal he/she/they executed it. WITNESS my hand and official seal. Donna Maris Boel. Notary Publio Maricopa County, Arizona My Comm. Expiros 07-21-2023] Gammlssion No, 566487 Notary Seal For Bank Purposes Only Description of Attached Document Type or Title of Document \ Schools AS fideo Cl inform Document Dat Number of Pag es coe “ N32 oe bab 2 9 i Le if “ | ‘ Signer(s) Other Than Named Above AY 2) f AN brung ) VOAAL (os dude a (Signature of Notary Public) My commission expires Optional: A thumbprint is only needed if slate stal- ules require a thumbpnnl. Right thumbprint: ‘of Signer = Top of thumb here eee a Account Number (if ‘applicable) ee Le icreomt INNA POOL 0$G5360/595575 (Rey 04 ~ 05/21) -000 PHOENIX, AR THIS WARRANT DRAWS INTEREST FROM DATE MARKED “INSUFFICIENT FUNDS" INTEREST STOPS ON DATE FUNDS AVAILABLE, (SEC 11-636, ARS1956) Buckeye Elementary District #33 AY *“Four Thousand Nine Hundred Seventy and 00/100** Dollars 2) Kari Suzanne Rambo. ub tene ‘DATE CONTROL N 04/22/2021 33625359 WARRANT AMOUNT _ $4,970.00 /\ a Steve Wi Superintendent ‘RS Ackizep SIGNATURES Securitv Features Included. ED betails on Ba IARICOPA COUNTY SCHOOLS - PHOENIX, ARIZONA 04/22/2021 Check: 33625359 EXPENSE AP 20210424 3700416532 Kari Suzanne Rambo. 04/22/2021 Payee Check Date Account Number PO Number Invoice Amount 210446 «(515 4,970.00 VOUCHER: 1182 TOTAL $4,970.00 HARLAND CLARKE M22692 00229286